Addressing Hospital-Acquired Hypoglycemia.

BACKGROUND: Hospitalized patients who have diabetes often experience hospital-acquired hypoglycemia, a potentially serious adverse event; as a result, management of this condition has become an important quality of care indicator in the inpatient environment. A growing body of research and evidence-based clinical guidelines support proper timing of point of care (POC) blood glucose (BG) measurements, mealtime insulin administration, and meal delivery to reduce the incidence of both hypoglycemic and hyperglycemic events. Monitoring and improving the timing of these three patient care interventions are recognized as a crucial step in the safe and effective care of patients with diabetes. PURPOSE: The objective of the QI project was to improve the timing of mealtime insulin administration related to bedside BG monitoring and meal delivery for patients with diabetes who receive mealtime insulin; a secondary goal was to decrease the number of episodes of recurrent hypoglycemia. The overall strategy was to change staff members' approach to mealtime insulin management from a series of individual tasks to a process-oriented collaborative approach. METHODS: Nurses on the medical-surgical unit at one hospital within a large health system formed a QI team with staff members in information technology and food and nutrition services. The team implemented an eight-week QI pilot project (July 3 to August 26, 2017) using a multidisciplinary approach to coordinate between POC BG measurement, mealtime insulin administration, and meal delivery. RESULTS: More than two years after the hospital-wide rollout of the practice change, follow-up analysis has shown that, on both noncritical and critical care units, recurrent hypoglycemia has decreased. For example, comparing data obtained in a six-month period before the pilot project (November 2016 through April 2017) with the same six-month period in 2018 and 2019, more than a year after the pilot project, the percentage of patient stays (admissions) on noncritical care units in which there was a recurrence of hypoglycemia fell from 41.8% (of 1,162 total hospital admissions) to 35.1% (of 792 total hospital admissions); similarly, the percentage of patient stays on critical care units in which recurrent hypoglycemia occurred decreased from 36.8% to 22.8%. CONCLUSIONS: Findings suggest that ensuring a consistent 30-minute window between POC BG measurement and meal delivery enabled nursing staff to perform timely POC BG measurements and administer a more optimal mealtime insulin dose. Increasing interdisciplinary communication, collaboration, and awareness of best practice guidelines relating to proper mealtime insulin administration resulted in a sustained improvement in timing between POC BG measurements and mealtime insulin administration and between mealtime insulin administration and meal delivery.

Waste generation and carbon emissions of a hospital kitchen in the US: Potential for waste diversion and carbon reductions.

This study measured the total quantity and composition of waste generated in a large, New York City (NYC) hospital kitchen over a one-day period to assess the impact of potential waste diversion strategies in potential weight of waste diverted from landfill and reduction in greenhouse gas (GHG) emissions. During the one-day audit, the hospital kitchen generated 1515.15 kg (1.7 US tons) of solid waste daily or 0.23 kg of total waste per meal served. Extrapolating to all meals served in 2019, the hospital kitchen generates over 442,067 kg (487 US tons) of waste and emits approximately 294,466 kg of CO2e annually from waste disposal. Most of this waste (85%, 376,247 kg or 415 US tons annually) is currently sent to landfill. With feasible changes, including increased recycling and moderate composting, this hospital could reduce landfilled waste by 205,245 kg (226 US tons, or 55% reduction) and reduce GHG emissions by 189,025 kg CO2e (64% reduction). Given NYC's ambitious waste and GHG emission reduction targets outlined in its OneNYC strategic plan, studies analyzing composition, emissions, and waste diversion potential of large institutions can be valuable in achieving city sustainability goals.

RECALSEEN. La atención al paciente en las unidades de Endocrinología y Nutrición del Sistema Nacional de Salud / Patient care in the Endocrinology and Nutrition Units of the National Health System. The RECALSEEN study

Objetivos: Elaborar un registro de situación de los Servicios y Unidades de Endocrinología y Nutrición (S°EyN) del Sistema Nacional de Salud (SNS) y valorar sus recursos asistenciales para desarrollar, a partir de los resultados obtenidos, propuestas de políticas de mejora en los S°EyN. Material y métodos: Estudio descriptivo transversal de los pacientes atendidos en los S°EyN en hospitales generales de agudos del SNS en 2016. Se utilizaron datos obtenidos mediante RECALSEEN 2017, una encuesta «ad hoc» diseñada específicamente para este fin y de las altas dadas por los S°EyN registradas en el CMBD del SNS (2015). Resultados: De un total de 125 hospitales generales de agudos de más de 200 camas instaladas del SNS español, se han obtenido 88 respuestas de los S°EyN, que representan el 70%. El 47% de los S°EyN que respondieron eran servicios y el 31% secciones. El promedio de endocrinólogos por S°EyN era de 7,4±4,4, siendo la tasa media de endocrinólogos por cada 100.000 habitantes de 2,3±1. Las actividades asistenciales más relevantes eran la consulta (promedio de 12,3 primeras consultas por mil habitantes y año), hospital de día (mediana de 2.000 sesiones/año) e interconsulta hospitalaria (mediana de 900 interconsultas/año). El 83% de los S°EyN incorporaban una Unidad de Nutrición Clínica. La dotación de dietistas, técnicos en nutrición y bromatólogos en las Unidades de Nutrición Clínica era baja. En relación con la gestión de la calidad se detectó un amplio margen de mejora; solamente un 35% de los S°EyN tenían responsable de calidad y el 38% había implantado una gestión por procesos para aquellos más frecuentemente atendidos por la unidad. Existen notables diferencias en estructura, recursos y actividad de los S°EyN entre Comunidades Autónomas. Conclusiones: La encuesta RECALSEEN 2017 es útil para el análisis de los S°EyN. La notable variabilidad hallada en los indicadores de estructura, actividad y gestión probablemente indica relevantes diferencias y, por tanto, un amplio margen de mejora

Objectives: To elaborate a diagnosis of the situation regarding the assistance in the Services and Units of Endocrinology and Nutrition (S°EyN) of the National Health System of Spain (SNHS) and to develop, based on the results obtained, proposals for improvement policies in the S°EyN. Material and methods: Cross-sectional descriptive study of the patients treated in the S°EyN departments of acute general hospitals of the SNHS in 2016. Data were obtained through RECALSEEN 2017, an "ad hoc" survey designed specifically for this purpose, and the Minimum Basic Data Set of discharges given by the S°EN of the SNHS (2015). Results: 88 responses of S°EyN have been obtained forma total of 125 acute general hospitals of more than 200 beds installed in the SNHS (70% answers). 47% of the S°EyN respondents were services and 31% sections. The average of endocrinologists by S°EyN was 7.4±4.4, and the average rate of endocrinologists per 100,000 inhabitants was 2.3±1. The most relevant care activities were the consultation (average of 12.3 first consultations per thousand inhabitants and year), day hospital (median of 2,000 sessions/year) and in-hospital consultations (median of 900 in-hospital consultations/year). 83% of S°EyNhad a Clinical Nutrition Unit. The number of dietitians, nutrition technicians and nutritionists in the Clinical Nutrition Unit was low. In relation to quality management, a large margin for improvement was detected; only 35% of S°EyN had a responsible of quality and 38% had implemented process management for those most frequent processes in the unit. There were notable differences in structure, resources and activity of S°EyN between Autonomous Communities. Conclusions: RECALSEEN 2017 survey is a useful tool for the analysis of S°EyN. The remarkable variability found in the structure, activity and management indicators probably indicates significant differences and, therefore, a wide margin for improvement

Proceso de alimentación hospitalaria / Hospital feeding process

El Grupo de Trabajo de Gestión de SENPE tiene entre sus objetivos el desarrollo de procesos de evaluación en Nutrición Clínica. Con anterioridad se elaboró el documento denominado "Proceso de atención nutricional: guía de autoevaluación", como una herramienta concebida para ayudar a evaluar la calidad de la terapia nutricional en pacientes hospitalizados, fundamentalmente desde la perspectiva de la nutrición artificial. Ahora se presenta un texto complementario del anterior, en el que se describe el proceso por el que alimenta a los pacientes hospitalizados. Hemos dividido el proceso de alimentación hospitalaria en seis secciones, para las que se hace una descripción general y se proponen indicadores de calidad para su evaluación. Confiamos en que este trabajo sirva para mejorar la calidad de las dietas de los hospitales y para ayudar a los profesionales de la alimentación de los hospitales a hacer su labor más satisfactoria y efectiva

The Management Working Group of SENPE has among its objectives the development of evaluation processes in clinical nutrition. Previously, the document entitled "Process of nutritional care: self-evaluation guide" was prepared as a tool designed to help assess the quality of nutritional therapy in hospitalized patients, mainly from the perspective of artificial nutrition. Now, a complementary text of the previous one is presented, describing the process by which hospitalized patients are fed. We have divided the hospital feeding process into six sections, for which a general description is made and quality indicators are proposed. We hope that this work will serve to improve the quality of hospital food and help hospital food professionals to make their work more satisfactory and effective

Nutritional support strategies in pediatric cancer patients in Mexico / Estrategias de soporte nutricio en pacientes pediátricos con cáncer en México

Background: Meeting the nutritional needs of pediatric patients on oncology services in low budget public hospitals of Mexico is a continuous challenge, due to its financial resources. Objective: To evaluate the effectiveness of a nutritional strategy for children and adolescents with cancer in a public hospital of Mexico, based on a complacency diet. Methods: Across-sectional study included 58 children and adolescents (1-18 years old). An assessment of nutritional status was applied and a dietary diary was elaborated for 24 hours with the double weight method. Results: 43 patients (74.4%) had an adequate nutritional status. The average energy intake was 72.8% and average protein intake 168.3% of the requirements. The hospital meals accounted for 67.5% of the energy intake, 28.5% resulted from snacks and 3.9% from oral nutritional supplements or polymeric smoothies. Conclusion: The nutritional strategy based on offering a menu at the request supported by smoothies or oral nutritional supplements and the permission to introduce snacks to the hospital offers convenience and flexibility for meal times and favors the energy intake in hospitalized pediatric oncology patients.

Introducción: debido a la escasez de recursos económicos, los hospitales públicos de México tienen un reto continuo para satisfacer las necesidades nutricionales de niños en los servicios de oncología pediátrica. Objetivo: evaluar la eficacia de una estrategia nutricional en niños y adolescentes con cáncer, de un hospital público de México, basada en una dieta a complacencia. Métodos: se llevó a cabo un estudio transversal en el que se incluyeron 58 niños y adolescentes (1-18 años de edad). Se realizó una evaluación antropométrica del estado nutricio y se elaboró un diario dietético durante 24 horas con el método de doble pesada. Resultados: 43 pacientes (74.4%) tenían un estado nutricio adecuado. El consumo promedio de energía fue 72.8% y de proteínas 168.3% del requerimiento. Del total de las calorías consumidas 67.5% provenían del menú hospitalario, 28.5% de refrigerios y 3.9% de suplementos alimenticios o licuados artesanales. Conclusión: la estrategia nutricional basada en una dieta a complacencia apoyada por licuados y suplementos alimenticios más un permiso para la introducción de refrigerios al hospital, favoreció la ingestión calórica, ofreció comodidad y flexibilidad durante las horas de comida a los pacientes oncológicos pediátricos hospitalizados.

Qualidade microbiológica de dieta livre e viabilidade para pacientes imunossuprimidos / Microbiological quality of regular diet and viability for immunosuppressed patients

Introdução: O câncer é uma enfermidade caracterizada pelo crescimento desordenado de células anormais cujo tratamento pode desencadear imunossupressão. Pacientes imunossuprimidos são mais susceptíveis a micro-organismos oportunistas, que em contato com o organismo, podem levar a quadros infecciosos graves. Assim, a dieta para imunossuprimidos é utilizada com a finalidade de diminuir o risco de doenças transmitidas por alimentos, através da restrição de alimentos como vegetais crus e as frutas com casca fina. Objetivo: Verificar a qualidade microbiológica da dieta livre e a viabilidade de sua oferta para pacientes imunossuprimidos Métodos: Pesquisou-se nos meses de abril a maio de 2016, 120 amostras de componentes da dieta livre (arroz, feijão, prato proteico, guarnição, salada e fruta). As amostras foram submetidas à análise microbiológica de acordo com a legislação vigente para quantificação de Coliformes a 45ºC, Staphylococcus coagulase positiva, Bacillus cereus, Clostridium sulfito redutor e análise de presença de Salmonella sp, seguindo metodologia preconizada pela American Public Health Association. Resultados: Todas as amostras analisadas estavam em conformidade com a legislação vigente. Discussão: Estudos demonstram que a relação entre dieta para imunossuprimidos e diminuição do risco de contaminantes alimentares e infecção permanece contraditória. A prevalência de complicações ou desfechos clínicos desfavoráveis são maiores entre pacientes que ingerem a dieta neutropênica ou aparecem neutras, quando comparadas a dieta livre. Em contrapartida, a aceitação alimentar pela dieta neutropênica é reduzida e visível a piora do estado nutricional do paciente. Conclusão: Foi considerada viável a oferta de dieta livre aos pacientes imunossuprimidos

Introduction: Cancer is a disorder characterized by the disordered growth of abnormal cells whose treatment can trigger immunosuppression. Immunosuppressed patients are more susceptible to opportunistic microorganisms, which in contact with the organism, can lead to serious infectious conditions. Thus, the immunosuppressed diet is used to reduce the risk of foodborne illness by restricting foods such as raw vegetables and fruits with thin bark. Objective: Verify the microbiological quality of the geral diet and the viability of its offer for immunosuppressed patients.Methods: From April to May 2016, 120 samples of free diet components (rice, beans, protein plate, garnish, salad and fruit) were investigated. The samples were submitted to microbiological analysis according to the current legislation for the quantification of Coliforms at 45ºC, Staphylococcus coagulase positive, Bacillus cereus, Clostridium sulfite reducer and analysis of the presence of Salmonella sp, following a methodology recommended by the American Public Health Association. Results: All samples analyzed were in compliance with current legislation. Discussion: Studies have shown that the relationship between diet for immunosuppressed and decreased risk of food contaminants and infection remains contradictory. The prevalence of unfavorable complications or clinical outcomes is greater among patients who ingest the neutropenic diet or appear neutral when compared to the geral diet. On the other hand, the food acceptance by the neutropenic diet is reduced and the deterioration of the nutritional status of the patient is visible. Conclusion: The availability of geral diet to immunosuppressed patients was considered feasible

No disponible

Dietética hospitalaria y gastronomía saludable / Hospital feeding and healthy gastronomy

Introducción: en los últimos años está dándose mucha relevancia a la gastronomía dentro del campo de la dietética. La alimentación en todo tipo de colectividades es un reto para los profesionales de la salud que tienen la responsabilidad de diseñar, planificar, programar y controlar la elaboración de dietas. Existen muchos factores relacionados con la ingesta que deben tenerse en cuenta a la hora de diseñar la actuación del servicio de dietética o alimentación: recursos hospitalarios, organizativos, geográficos, culturales, etc., sin olvidar los factores nutricionales y gastronómicos; un equilibrio que logra finalmente que el acto de comer se realice de manera espontánea y satisfactoria. Objetivo: el objetivo es revisar los factores implicados en la dietética hospitalaria integrando el factor gastronómico. Métodos: se ha realizado una revisión de los principales informes publicados, artículos científicos y capítulos de libros sobre dietética hospitalaria y gastronomía. Conclusiones: la comida hospitalaria, más que ninguna otra, requiere de la colaboración de nutrición y dietética con cocina y alimentación, ya que deben ir encaminadas hacia el mismo fin: la correcta alimentación de los pacientes ingresados y de la manera culinaria más agradable posible. En los centros hospitalarios, la armonía entre cocineros, dietistas-nutricionistas y profesionales sanitarios es un reto apasionante que repercute directamente en el beneficio del paciente

Background: in the last years, the gastronomy is becoming very important in the field of food. Food, in all types of collectives, is a challenge for health professionals who have the responsibility of designing, planning, scheduling and controlling the elaboration of diets. There are many factors related to intake that must be taken into account when designing the performance of the dietetic or food service: hospital resources, organizational, geographical, cultural... without forgetting the nutritional and gastronomic factors, a balance that makes the act of eating happen spontaneously and satisfactorily. Objective: the objective is to review the factors involved in hospital dietetics by integrating the gastronomic factor. Methods: it has been made a review of the main published reports, scientific articles and book chapters on hospital dietetics and gastronomy. Conclusions: hospital food requires more than any other nutrition and dietetic collaboration with food and cooking since both should be directed towards the same end, the correct feeding of the patients admitted, in the most pleasant culinary way possible. In hospitals, harmony among cooks, dieticians and health professionals is an exciting challenge that has a direct impact on the patient's benefit

[Hospital feeding and healthy gastronomy]. / Dietética hospitalaria y gastronomía saludable.

BACKGROUND: in the last years, the gastronomy is becoming very important in the field of food. Food, in all types of collectives, is a challenge for health professionals who have the responsibility of designing, planning, scheduling and controlling the elaboration of diets. There are many factors related to intake that must be taken into account when designing the performance of the dietetic or food service: hospital resources, organizational, geographical, cultural... without forgetting the nutritional and gastronomic factors, a balance that makes the act of eating happen spontaneously and satisfactorily. OBJECTIVE: the objective is to review the factors involved in hospital dietetics by integrating the gastronomic factor. METHODS: it has been made a review of the main published reports, scientific articles and book chapters on hospital dietetics and gastronomy. CONCLUSIONS: hospital food requires more than any other nutrition and dietetic collaboration with food and cooking since both should be directed towards the same end, the correct feeding of the patients admitted, in the most pleasant culinary way possible. In hospitals, harmony among cooks, dieticians and health professionals is an exciting challenge that has a direct impact on the patient's benefit.

Introducción: en los últimos años está dándose mucha relevancia a la gastronomía dentro del campo de la dietética. La alimentación en todo tipo de colectividades es un reto para los profesionales de la salud que tienen la responsabilidad de diseñar, planificar, programar y controlar la elaboración de dietas. Existen muchos factores relacionados con la ingesta que deben tenerse en cuenta a la hora de diseñar la actuación del servicio de dietética o alimentación: recursos hospitalarios, organizativos, geográficos, culturales, etc., sin olvidar los factores nutricionales y gastronómicos; un equilibrio que logra finalmente que el acto de comer se realice de manera espontánea y satisfactoria.Objetivo: el objetivo es revisar los factores implicados en la dietética hospitalaria integrando el factor gastronómico.Métodos: se ha realizado una revisión de los principales informes publicados, artículos científicos y capítulos de libros sobre dietética hospitalaria y gastronomía.Conclusiones: la comida hospitalaria, más que ninguna otra, requiere de la colaboración de nutrición y dietética con cocina y alimentación, ya que deben ir encaminadas hacia el mismo fin: la correcta alimentación de los pacientes ingresados y de la manera culinaria más agradable posible. En los centros hospitalarios, la armonía entre cocineros, dietistas-nutricionistas y profesionales sanitarios es un reto apasionante que repercute directamente en el beneficio del paciente.

Comparison of Patient Food Intake, Satisfaction and Meal Quality Between Two Meal Service Styles in a Geriatric Inpatient Unit.

This pilot study evaluated the introduction of a bistro evening meal service in a geriatric inpatient unit by comparing patient intake, satisfaction and meal quality of this new service to the usual central preplated service. Ten meals were observed under each condition (n = 30; mean age 79 years, 47% male). Data were collected on intake of each meal component (none, », ½, ¾, all; converted to energy and protein using known food composition data), patient satisfaction with meals (meal flavor/taste, appearance, quality, staff demeanor; seven-point scale) and meal quality (sensory properties, temperature; five-point scale). Independent t-tests were used to compare energy and protein intakes between bistro and preplated services. There was no difference in mean energy or protein intake (energy: 2524 ± 927 kJ vs. 2692 ± 857 kJ, p = 0.612; protein: 29 ± 12 g vs. 27 ± 11 g, p = 0.699) patient satisfaction or meal quality between the bistro and preplated meal services. Patients were provided with fewer meal items during the bistro service, but ate a higher proportion of what was provided to them. Implementing a bistro service did not increase intake, satisfaction or meal quality in this study, suggesting that meal plating may be only one of many factors influencing intake and satisfaction of older inpatients.

Ingredients for Success: Strategies to Support Local Food Use in Health Care Institutions.

There is growing interest in use of local food within health care institutions such as hospitals and long-term care homes. This study explored stakeholder perspectives on (i) influences on local food use and (ii) strategies that support success and sustainability of use in health care institutions. Fifteen participants who were institutional leaders with experience in implementing or supporting local food use in health care institutions in Ontario were recruited through purposeful and snowball sampling. A semi-structured interview was conducted by telephone and audio-recorded. Qualitative content analysis identified that influences on local food use were: product availability, staff and management engagement, and legislation and resources (e.g., funding, labour). Several strategies were offered for building and sustaining success including: setting goals, requesting local food availability from suppliers, and more clearly identifying local foods in product lists. The influences and potential strategies highlighted in this paper provide a greater understanding for dietitians and food service managers on how local foods can be incorporated into health care institutions.

Low food intake in hospital: patient, institutional, and clinical factors.

In-hospital malnutrition and inadequate food intake have been associated with negative outcomes (e.g., prolonged length of stay, readmission, mortality, and increased hospital costs). Studies examining the factors associated with low food intake in hospital, commonly defined as the consumption of ≤50% of meals, have produced mixed results. We examined the correlates of food intake including patient socioeconomic, demographic, and health characteristics, institutional factors, and common clinical strategies in 1129 medical patients from 5 Canadian hospitals. Low food intake was found in 35% of patients (41% of females and 29% of males) (p < 0.001). In multivariate analyses, sex, socioeconomic status, demographics, and diagnoses were not significantly related to food intake. Patients assessed as malnourished (subjective global assessment (SGA) B/C) (odds ratio (OR), 2.41; p = 0.003) or as not at risk of malnutrition (OR, 1.67; p = 0.040) were more likely to have low intake when compared with those assessed as well nourished (SGA A). Patient reports of mealtime challenges (OR, 2.70; p < 0.001) and barriers to food intake (OR, 1.11; p = 0.008) were positively related to low intake throughout the study sample. Higher 12-Item Short Form Health Survey Mental Component Summary scores were related to better food intake (OR, 0.98; p < 0.001). Clinical strategies such as between-meal snacks lowered the likelihood of low food intake (OR, 0.55; p = 0.037), whereas a group of "other strategies" increased the odds (OR, 2.77; p = 0.001). These results offer a better understanding of the correlates of in-hospital low food intake. The conclusion discusses some avenues for improving food intake in the clinical setting, such as better mealtime monitoring and a reduction in barriers to food intake.

Nudging Healthier Choices in a Hospital Cafeteria: Results From a Field Study.

More than two thirds of adults and one third of children are overweight or obese in the United States. These trends have led to initiatives to provide information that supports informed choices. Traffic light labeling has been shown to increase consumer awareness and encourage healthy selections. This article contributes to the literature on healthy choices by comparing the additional contribution of a number of interventions used in combination with traffic light labeling. We conducted a 21-month field study in a workplace cafeteria. We analyzed cash register receipts, focusing on sales of beverages and chips. We found that the traffic light system was effective. The addition of caloric information to traffic light labeling had a positive effect on the purchase of healthy chips. However, other interventions appeared to produce more harm than good, essentially wiping out the benefits from traffic light labeling. These findings suggest that although it is possible to improve on traffic light labeling with selective interventions, caution is in order as some interventions may trigger compensatory behavior that results in the purchase of unhealthy items.

"Meal realities" - An ethnographic exploration of hospital mealtime environment and practice.

AIM: To explore and understand patterns of mealtime culture, environment and social practice from the perspective of staff, volunteers and visitors on the hospital ward. BACKGROUND: Inadequate food intake is a common and complex problem in hospital and can lead to malnutrition. Mealtime interventions have been implemented to address this problem with limited success. A better understanding of mealtime environment and practice is needed to ascertain which interventions are more likely to be effective in addressing inadequate food intake in hospital. DESIGN: A qualitative, ethnographic approach was used to promote a comprehensive understanding of mealtime environment and practice. METHODS: Sixty-seven hours of fieldwork was conducted August-October 2015. More than 150 participants were observed and 61 unique participants were interviewed in 75 interviews. Data analysis followed an inductive, thematic approach, informed by systems and complexity theory. FINDINGS: Themes of "patient centredness" and "system" and their disharmonious interrelationship emerged. Staff, volunteers and visitors strive for patient centredness at mealtimes. The routine and structured nature of the meal and care systems was constantly in tension with providing patients the care they needed. CONCLUSION: The findings of this study expose the challenges associated with maintaining patient centredness at mealtimes in complex healthcare and foodservice systems. This facilitates a better understanding of why inadequate food intake is difficult to address in the hospital setting and highlights the need to support strategies that approach foodservice processes and nutritional care as complex and non-linear.

Effect of the implementation of the mixed cafeteria system in a hospital nutrition and dietetic service.

INTRODUCTION: The type of service offered by the nutrition and dietetics service (NDS) of a hospital has a direct impact on food waste. OBJECTIVE: To evaluate waste in the transition from a simple to a mixed cafeteria service. METHODOLOGY: The study was carried out in a NDS of a University Hospital during 60 days (30 days for each type of service). The meals prepared and distributed and the leftovers of lunch and dinner were weighed. RESULTS: Per capita values of non-usable leftovers were below the acceptable range (7-25 g), not varying with the service transition (p = 0.3) at lunch. At dinner, on the contrary, values were above the acceptable range, with a median of 190 g and 202 g, also showing no difference with the service modification (p = 0.5). At lunch, with the transition, there was a reduction in the plate waste-ingestion (p < 0.0001), percentage of plate waste-ingestion (p < 0.0001) and percentage of non-usable foods (p = 0.007). At dinner, there was a reduction in the plate waste-ingestion (p < 0.0001) and in the percentage of plate waste-ingestion (p = 0.0001). CONCLUSION: The modification of the service type was effective in reducing the plate waste-ingestion, but did not lead to operational modifications of the service, since the amount of non-usable leftovers remained high at dinner. Greater control of the production and distribution of meals is suggested, as well as training of food handlers and supervisors, implementation of standardized operating procedures and cost control in order to reduce waste, which has an economic, social and political impact.

Effect of the implementation of the mixed cafeteria system in a hospital nutrition and dietetic service / Efecto de la implementación del sistema de cafetería mixto en el servicio de nutrición y dietética de un hospital

Introduction: The type of service offered by the nutrition and dietetics service (NDS) of a hospital has a direct impact on food waste. Objective: To evaluate waste in the transition from a simple to a mixed cafeteria service. Methodology: The study was carried out in a NDS of a University Hospital during 60 days (30 days for each type of service). The meals prepared and distributed and the leftovers of lunch and dinner were weighed. Results: Per capita values of non-usable leftovers were below the acceptable range (7-25 g), not varying with the service transition (p = 0.3) at lunch. At dinner, on the contrary, values were above the acceptable range, with a median of 190 g and 202 g, also showing no difference with the service modification (p = 0.5). At lunch, with the transition, there was a reduction in the plate waste-ingestion (p < 0.0001), percentage of plate waste-ingestion (p < 0.0001) and percentage of non-usable foods (p = 0.007). At dinner, there was a reduction in the plate waste-ingestion (p < 0.0001) and in the percentage of plate waste-ingestion (p = 0.0001). Conclusion: The modification of the service type was effective in reducing the plate waste-ingestion, but did not lead to operational modifications of the service, since the amount of non-usable leftovers remained high at dinner. Greater control of the production and distribution of meals is suggested, as well as training of food handlers and supervisors, implementation of standardized operating procedures and cost control in order to reduce waste, which has an economic, social and political impact (AU)

Introducción: el tipo de servicio ofrecido por el servicio de nutrición y dietética (SND) de un hospital tiene un impacto directo en el desperdicio de alimentos. Objetivo: evaluar el desperdicio en la transición de un servicio de cafetería simple a uno combinado. Metodología: el estudio fue llevado a cabo en el SND de un hospital universitario durante 60 días (30 días para cada tipo de servicio). Las comidas preparadas, distribuidas y las sobras del almuerzo y cena fueron pesadas. Resultados: los valores per cápita de las sobras no aprovechables estuvieron por debajo del rango aceptable (7-25 g), sin que variaran con la transición del servicio (p = 0,3) en el almuerzo. En la cena, por el contrario, los valores estuvieron por encima del rango aceptable, con una mediana de 190 g y 202 g, y sin mostrar tampoco una diferencia significativa con la modificación del servicio (p = 0,5). En el almuerzo, con la transición, hubo una reducción en el desperdicio de alimento-ingesta (p < 0,0001), porcentaje del desperdicio de alimento-ingesta (p < 0,0001) y porcentaje de comidas no utilizables (p = 0,007). En la cena, hubo una reducción en el desperdicio de alimento-ingesta (p < 0,0001) y en el porcentaje desperdicio-ingestión (p = 0,0001). Conclusión: la modificación del tipo de servicio fue efectiva a la hora de reducir el desperdicio de alimento-ingesta, pero no condujo a modificaciones operativas en el servicio ya que la cantidad de sobras no utilizables era mayor en la cena. Se sugiere un mayor control de la producción y distribución de las comidas, así como la formación de responsables y supervisores de comida, la implementación de procedimientos operativos estandarizados y el control del coste para reducir el desperdicio, que tiene un impacto económico, social y político (AU)

Impact of kitchen organization on oral intake of malnourished inpatients: A two-center study / Impacto de la organización de la cocina hospitalaria en la ingesta del paciente malnutrido: estudio de dos centros

Aim: To determine the impact of the type of hospital kitchen on the dietary intake of patients. Methods: A cross-sectional, two-centre study, of cooking in a traditional kitchen (TK) and in a chilled kitchen (CK). Subjective global assessment (SGA) was used for nutritional diagnosis. Before study start, a dietician performed a nutritional assessment of the menus of each hospital. All dishes were weighed upon arrival to the ward and at the end of the meal. Results: 201 and 41 patients from the centres with TK and CK respectively were evaluated. Prevalence of malnutrition risk was 50.2% at the hospital with TK and 48.8% at the hospital with CK (p=0.328). Forty-eight and 56 dishes were nutritionally evaluated at the hospitals with TK and CK respectively. Intake analysis consisted of 1993 and 846 evaluations in the hospitals with TK and CK respectively. Median food consumption was 76.83% at the hospital with TK (IQR 45.76%) and 83.43% (IQR 40.49%) at the hospital with CK (p<0.001). Based on the prevalence of malnutrition, a higher protein and energy intake was seen in malnourished patients from the CK as compared to the TK hospital, but differences were not significant after adjustment for other factors. Conclusions: Cooking in a chilled kitchen, as compared to a traditional kitchen, may increase energy and protein intake in hospitalized patients, which is particularly beneficial for malnourished patients (AU)

Objetivo: Determinar el impacto de la organización de la cocina hospitalaria en la ingesta dietética del paciente hospitalizado. Metodología: Estudio transversal, realizado en dos centros hospitalarios, uno con cocina tradicional (CT) y otro con cocina en línea fría (CLF). La valoración subjetiva global fue empleada para el diagnóstico nutricional. Una dietista-nutricionista realizó una calibración nutricional de los platos y los menús de cada hospital antes de empezar el estudio. La técnica de valoración de la ingesta fue la pesada de alimentos antes y después de la ingesta, siempre en presencia del paciente. Resultados: Fueron reclutados 201 pacientes del centro con CT y 41 del CLF. La prevalencia de riesgo de desnutrición fue del 50,2% en el CT y de 48,8% en el CLF (p=0,328). En el CT fueron valorados nutricionalmente 48 platos y 56 del CLF. Respecto al análisis de la ingesta, se realizaron 1.993 registros en el centro CT y 846 en el centro CLF. La mediana de ingesta en el CT fue de 76,83% (RIC 45,76%) y 83,43% (RIC 40,49%) en el CLF (p<0,001). Teniendo en cuenta la prevalencia de malnutrición, se observó una mayor ingesta proteica y energética en pacientes malnutridos en el CLF en comparación con el CT, aunque estas diferencias no fueron significativas tras ajustarlas a diferentes factores de confusión. Conclusiones: Cocinar en una cocina en línea fría podría mejorar la ingesta calórica y proteica del paciente hospitalizado, especialmente en pacientes malnutridos (AU)

Impact of kitchen organization on oral intake of malnourished inpatients: A two-center study.

AIM: To determine the impact of the type of hospital kitchen on the dietary intake of patients. METHODS: A cross-sectional, two-centre study, of cooking in a traditional kitchen (TK) and in a chilled kitchen (CK). Subjective global assessment (SGA) was used for nutritional diagnosis. Before study start, a dietician performed a nutritional assessment of the menus of each hospital. All dishes were weighed upon arrival to the ward and at the end of the meal. RESULTS: 201 and 41 patients from the centres with TK and CK respectively were evaluated. Prevalence of malnutrition risk was 50.2% at the hospital with TK and 48.8% at the hospital with CK (p=0.328). Forty-eight and 56 dishes were nutritionally evaluated at the hospitals with TK and CK respectively. Intake analysis consisted of 1993 and 846 evaluations in the hospitals with TK and CK respectively. Median food consumption was 76.83% at the hospital with TK (IQR 45.76%) and 83.43% (IQR 40.49%) at the hospital with CK (p<0.001). Based on the prevalence of malnutrition, a higher protein and energy intake was seen in malnourished patients from the CK as compared to the TK hospital, but differences were not significant after adjustment for other factors. CONCLUSIONS: Cooking in a chilled kitchen, as compared to a traditional kitchen, may increase energy and protein intake in hospitalized patients, which is particularly beneficial for malnourished patients.